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In patients receiving care for HIV infection during the COVID-19 pandemic, there was a decrease in outpatient visits, HIV viral load surveillance, and the proportion of those who achieved virologic suppression. Moreover, the pandemic also saw an increase in mental health encounters among this patient population. These findings were published in AIDS and Behavior.
This retrospective, observational, cross-sectional study included patients aged 18 years and older who were receiving care for HIV infection at a clinic in Tennessee affiliated with Vanderbilt university medical center. The researchers sought to assess how the COVID-19 pandemic affected outcomes of HIV care, including new patient visits, follow-up visits, viral load surveillance and virologic suppression, as well as mental health encounters. These outcomes of HIV care were compared against those that occurred in the second quarter of each calendar year within the 3 years prior to the onset of the COVID-19 pandemic. Data for this study were captured from electronic health records, and eligible patients included those with at least 1 clinical visit for HIV care between January and June 2020.
Among patients included in the analysis, 49% were White, 43% were Black, 7% were Hispanic, and 53% were considered economically disadvantaged. Between April and June of 2020, there were a total of 1686 clinical visits for HIV care among these patients, which was a significant decrease compared with the 2468, 2560, and 2513 visits that occurred within the same period in 2017, 2018, and 2019, respectively. Further comparison of these time periods showed similar decreases in clinical visits after stratification by sex and race/ethnicity, with HIV care visits decreasing by 23% in patients who were Hispanic. Between 2019 and 2020, the number of patients who came to the clinic to establish care for HIV infection decreased by 23.5%.
In regard to HIV viral load surveillance, the number of patients who had a clinical visit but did not undergo polymerase chain reaction (PCR)-based HIV-1 RNA testing between July 2018 and July 2019 was decreased vs those who had a clinical visit between July 2019 and July 2020 (3.1% vs 4.3%). Despite this decrease in HIV viral load surveillance, additional comparison showed that the number of patients who achieved virologic suppression was similar in both periods (88.2% for 2018-2019 vs 88.1% for 2019-2020). Between January and June 2019, there was a decrease in both the proportion of patients who underwent PCR-based HIV-1 RNA testing (82.9%) or had achieved viral suppression (76.9%) compared with those who underwent testing (91.5%) or had achieved viral suppression (83.4%) between July and December 2020 (P <.001 for both).
Among the same population of patients, the researchers found that the total number of mental health encounters increased by 14% between 2019 and 2020. Of note, the number of telehealth visits for mental health during this period increased from 2 to 287, however, in-person visits for mental health decreased from 577 to 158. Compared with the second quarters of 2017, 2018, and 2019, the total number of prescription refills written by mental health providers for this population increased by 20% in the second quarter of 2020.
Limitations of this study included its observational design, single-center setting, and lack of longitudinal data. In addition, these results may not be generalizable to other populations of patients with HIV infection.
In regard to these findings, the researchers noted that “steps should be taken to link and retain patients [with HIV infection] in [clinical] care and increase access to mental health providers as the COVID-19 pandemic continues.”
Reference
Norwood J, Kheshti A, Shepherd BE, Rebeiro PF, Ahonkhai A, Kelly S, et al. The impact of COVID-19 on the HIV care continuum in a large urban southern clinic. AIDS Behav. Published online February 23, 2022. doi.10.1007/s10461-022-03615-7
